Cough is one of the most common symptoms among children. While most acute cough episodes are viral and resolve within 4 weeks, chronic cough persisting beyond 4 weeks warrants further evaluation. Pediatric-specific cough guidelines emphasizing algorithmic evaluation assist in early and accurate diagnosis for preventing long-term pulmonary complications. This article reviews evidence-based approaches to evaluating and managing acute and chronic cough in children, highlighting key diagnostic strategies and targeted treatment options.

Introduction: Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, first emerged in Wuhan, China, in late 2019. Besides respiratory involvement, COVID-19 may cause coagulation abnormalities, leading to thromboembolic events. Mild forms of acute pancreatitis have also been reported in patients with COVID-19 pneumonia. The aim of this case report is to highlight rare extrapulmonary manifestations of SARS-CoV-2 infection, with emphasis on pancreatic involvement. Case Report: A male patient was admitted with sore throat, dry cough, and fever up to 38.0°C. He had received the first dose of the Sinopharm COVID-19 vaccine three weeks prior and was obese (BMI 44.7 kg/m²). On admission, he developed pulmonary thromboembolism. Color Doppler ultrasonography of the lower extremities showed no signs of superficial or deep vein thrombosis. On the eleventh day of treatment, laboratory tests revealed elevated serum amylase, lipase, and leukocyte count. Abdominal ultrasonography demonstrated a hyperechoic, non-enlarged pancreas, consistent with mild acute pancreatitis. Given the widespread presence of endothelial cells, SARS-CoV-2 infection may affect multiple extrapulmonary organs, including the CNS, cardiovascular system, kidneys, pancreas, liver, and gastrointestinal tract. Conclusion: SARS-CoV-2 infection may lead not only to pneumonia but also to thromboembolic complications and mild acute pancreatitis. Awareness of such rare extrapulmonary manifestations is important for timely diagnosis and management.

Pneumocystis jirovecii pneumonia (PJP) is an opportunistic fungal infection that predominantly affects immunocompromised individuals. Reports in immunocompetent children are rare. We report the case of a previously healthy 5½‑year‑old Saudi girl who presented with fever, dry cough, and progressive respiratory distress. Her condition rapidly deteriorated, requiring pediatric intensive care admission and mechanical ventilation due to severe acute respiratory distress syndrome. Her course was complicated by pneumothorax, pneumomediastinum, and extensive surgical emphysema. Extensive microbiological investigations were negative except for bronchoalveolar lavage demonstrating Pneumocystis jirovecii using Gomori methenamine silver staining. The patient was treated with intravenous trimethoprim-sulfamethoxazole and supportive intensive care management with gradual clinical recovery. Immunological evaluation, including lymphocyte subsets, immunoglobulin levels, complement levels, vaccine antibody responses, and whole‑exome sequencing, revealed no evidence of primary or secondary immunodeficiency. Long‑term follow‑up for more than 10 years showed no recurrent severe infections. This case highlights that PJP may rarely occur in immunocompetent children and can present with life‑threatening respiratory failure. Awareness of this possibility is important in severe unexplained pneumonia.

BACKGROUND Foreign body aspiration (FBA) is a life-threatening pediatric emergency, most common in 1-3-year-olds due to immature swallowing reflexes and exploratory oral behaviors. Common aspirated items include nuts, food particles and small toys, presenting with variable symptoms such as cough, dyspnea, wheezing or acute respiratory failure. Delayed diagnosis or improper management causes severe complications like post-obstructive pneumonia, atelectasis, bronchiectasis and irreversible airway stenosis, increasing morbidity and treatment complexity. CASE REPORT A 16-month-old girl was admitted with persistent cough, progressive dyspnea, intermittent fever, hoarseness, and occasional cyanosis that developed 6 days after accidental pine nut ingestion. Initial flexible bronchoscopy at a local hospital failed due to the foreign body's rigid texture and deep impaction in the right lower lobe basilar bronchus. Chest CT confirmed a pine nut shell in the B9/B10 segmental bronchus with surrounding inflammation. She was transferred for combined rigid-flexible bronchoscopy to establish a secure airway and enable precise visualization before holmium laser fragmentation broke the shell into retrievable fragments for complete removal. Two-week follow-up showed symptomatic B9/B10 stenosis, which improved significantly after sequential 3.5 mm and 4.0 mm balloon dilation. Her respiratory symptoms resolved and imaging confirmed restored lobar ventilation. CONCLUSIONS Rigid-flexible bronchoscopy synergy benefits removal of large rigid foreign bodies in sub-main bronchi by combining rigid bronchoscopy's airway security with flexible bronchoscopy's maneuverability and visualization. Holmium laser safely fragments hard foreign bodies with minimal airway trauma, and sequential balloon dilation effectively treats post-FBA stenosis. Individualized application guided by clinical assessment and imaging optimizes pediatric FBA outcomes.

Generalized pustular psoriasis (GPP) in infancy is uncommon and is often precipitated by infection, drugs, or systemic inflammatory responses. Although viral illnesses such as influenza have been reported to trigger GPP, acute exacerbation secondary to respiratory syncytial virus (RSV) is rarely described. We report a case of a 2-year-old girl with a prior history of mild psoriasis who developed widespread sterile, small pustules several days after onset of RSV infection symptoms (cough and low-grade fever), consistent with an RSV-associated acute exacerbation of GPP. Laboratory testing was positive for RSV nucleic acid and showed markedly elevated inflammatory markers. The family denied any use of over-the-counter medications prior to rash onset; based on the timing of lesion appearance and characteristic histopathology on skin biopsy (subcorneal pustules, Kogoj pustules, and psoriasiform epidermal hyperplasia), acute generalized exanthematous pustulosis (AGEP) was excluded. Treatment and follow-up: the patient received oral acitretin combined with intravenous immunoglobulin and albumin, after which the cutaneous lesions resolved rapidly. At 1-month post-discharge follow-up, the condition remained stable without recurrence. RSV infection should be recognized as a potential trigger for acute exacerbation of GPP in young children. In febrile acute pustular eruptions, viral nucleic acid testing and histopathological examination are important to enable early, targeted intervention.

Silent gastroesophageal reflux disease (GERD) is an atypical form of reflux disease in which patients present predominantly with extra-esophageal manifestations rather than classic symptoms such as heartburn or acid regurgitation. In this form, gastric refluxate may reach the upper aerodigestive tract, leading to laryngeal or respiratory symptoms that are frequently misattributed to infectious or allergic conditions. The absence of typical gastrointestinal complaints often results in delayed diagnosis and repeated ineffective treatments. We report the case of a 27-year-old male who presented with acute dry cough and progressive hoarseness without gastrointestinal symptoms. After excluding infectious and allergic etiologies, and noting a poor response to antitussive and bronchodilator therapies, a presumptive clinical diagnosis was established. Recognition of dietary triggers and rapid symptom resolution following a 4-week empirical trial of proton pump inhibitor therapy-along with symptom recurrence upon temporary discontinuation-supported the diagnosis of silent GERD. This case highlights the importance of considering reflux-related etiologies in patients with unexplained cough and laryngeal symptoms to avoid diagnostic delays and unnecessary empirical treatments.

Tuberculosis (TB) presents with fever, night sweats, and cough. The antituberculous therapy (ATT) used to treat TB affects various systems, including the renal system and the hepatobiliary system. ATT-induced acute tubular necrosis (ATN) can have various presentations, such as fever, vomiting, diarrhea, abdominal pain, oliguria, and cola-colored urine. We present a case of a 56-year-old patient using ATT. He presented with the complaint of altered mental status, vomiting, jaundice, and cola-colored urine. Labs revealed elevated liver enzymes, elevated creatinine, anemia, and thrombocytopenia. The autoimmune profile was normal; however, the biopsy revealed ATN. In addition to supportive management, hemodialysis and steroid therapy were initiated. Discontinuation of rifampin along with continuation of modified ATT therapy led to improved renal function tests, platelet counts, and Hb levels.

Respiratory syncytial virus (RSV) is a major cause of acute respiratory infection (ARI) in young children, but evidence on burden from low- and middle-income countries has largely been derived from hospital-based studies. This prospective, community-based study estimated the burden of RSV-associated ARI among children younger than two years of age in rural Bangladesh.